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<form action="${domain}/admin/tenth/c" method="post" name="message" onsubmit="return checkForm(this)">
    <input name="oName" type="hidden" value="${oName}">
    <div width="1000" align="center">

        <h4>表4  2016年计划生育技术服务机构各项服务项目收支情况</h4>
        <table border="1" cellspacing="0" cellpadding="0">
            <tr>
                <th rowspan="2">服务项目</th>
                <th colspan="3">服务收费情况</th>
                <th colspan="3">服务支出情况</th>
            </tr>

            <tr>

                <td>年度收费总额（元）</td>
                <td>服务量（人次）</td>
                <td>次均收费水平（元/人次）</td>
                <td>卫生材料支出（元）</td>
                <td>药品支出（元）</td>
                <td>其他支出（元）</td>
            </tr>

            <tr>
                <td>全部计生技术服务</td>
                <td><input style="background-color:#D1D1D1" readonly  unselectable="on"></input></td>
                <td><input style="background-color:#D1D1D1" readonly  unselectable="on"></input></td>
                <td><input style="background-color:#D1D1D1" readonly  unselectable="on"></input></td>
                <td><input style="background-color:#D1D1D1" readonly  unselectable="on"></input></td>
                <td><input style="background-color:#D1D1D1" readonly  unselectable="on"></input></td>
                <td><input style="background-color:#D1D1D1" readonly  unselectable="on"></input></td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name=tenthC[0] value="一、计划生育" type="hidden">一、计划生育</td>
                <td><input name="tenthC[1]" type="number" step="0.01" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[2]" type="number" step="0.01" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[3]" type="number" step="0.01" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[4]" type="number" step="0.01" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[5]" type="number" step="0.01" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthCl[0]" type="number" step="0.01" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></td>
            </tr>

            <tr>

                <td><input readonly unselectable="on" name=tenthC[6] value="1、健康教育、咨询和指导" type="hidden">1、健康教育、咨询和指导</td>
                <td><input name="tenthC[7]" type="number" step="0.01" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[8]" type="number" step="0.01"></td>
                <td><input name="tenthC[9]" type="number" step="0.01"></td>
                <td><input name="tenthC[10]" type="number" step="0.01"></td>
                <td><input name="tenthC[11]" type="number" step="0.01"></td>
                <td><input name="tenthCl[1]" type="number" step="0.01"></td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name=tenthC[12] value="2、避孕药具发放" type="hidden">2、避孕药具发放</td>
                <td><input name="tenthC[13]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[14]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[15]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[16]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[17]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[2]" type="number" step="0.01"></td>
            </tr>


            <tr>
                <td><input readonly unselectable="on" name=tenthC[18] value="3、放置节育器" type="hidden">3、放置节育器</td>
                <td><input name="tenthC[19]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[20]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[21]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[22]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[23]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[3]" type="number" step="0.01"></td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name=tenthC[24] value="4、取出节育器" type="hidden">4、取出节育器</td>
                <td><input name="tenthC[25]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[26]" step="0.01" type="number"></input></td>
                <td><input name="tenthC[27]" step="0.01" type="number"></input></td>
                <td><input name="tenthC[28]"  step="0.01" type="number"></input></td>
                <td><input name="tenthC[29]"  step="0.01" type="number"></input></td>
                <td><input name="tenthCl[4]" type="number" step="0.01"></td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name=tenthC[30] value="5、输卵管结扎" type="hidden">5、输卵管结扎</td>
                <td><input name="tenthC[31]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[32]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[33]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[34]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[35]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[5]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[36] value="6、输精管结扎" type="hidden">6、输精管结扎</td>
                <td><input name="tenthC[37]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[38]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[39]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[40]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[41]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[6]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[42] value="7、放置皮下埋植" type="hidden" >7、放置皮下埋植</td>
                <td><input name="tenthC[43]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[44]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[45]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[46]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[47]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[7]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[48] value="8、取出皮下埋植" type="hidden">8、取出皮下埋植</td>
                <td><input name="tenthC[49]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[50]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[51]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[52]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[53]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[8]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[54] value="9、流产" type="hidden">9、流产</td>
                <td><input name="tenthC[55]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[56]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[57]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[58]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[59]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[9]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[60] value="10、其他计划生育服务（人流）" type="hidden">10、其他计划生育服务（人流）</td>
                <td><input name="tenthC[61]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[62]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[63]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[64]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[65]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[10]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[66] value="二、不孕不育预防" type="hidden">二、不孕不育预防</td>
                <td><input name="tenthC[67]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[68]"  style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[69]"  style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[70]"  style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[71]"  style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthCl[11]" type="number" step="0.01" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[72] value="1、衣原体感染筛查" type="hidden">1、衣原体感染筛查</td>
                <td><input name="tenthC[73]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[74]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[75]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[76]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[77]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[12]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[78] value="2、避免重复流产咨询和教育" type="hidden">2、避免重复流产咨询和教育</td>
                <td><input name="tenthC[79]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[80]" type="number" ></input></td>
                <td><input name="tenthC[81]"  type="number" ></input></td>
                <td><input name="tenthC[82]"  type="number" ></input></td>
                <td><input name="tenthC[83]"  type="number" ></input></td>
                <td><input name="tenthCl[13]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[84] value="三. 孕前优生检查" type="hidden">三. 孕前优生检查</td>
                <td><input name="tenthC[85]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[86]"  style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[87]"  style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[88]"  style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[89]"  style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthCl[14]" type="number" step="0.01" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[90] value="1.优生健康教育" type="hidden">1.优生健康教育</td>
                <td><input name="tenthC[91]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[92]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[93]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[94]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[95]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[15]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[96] value="2.病史询问" type="hidden">2.病史询问</td>
                <td><input name="tenthC[97]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[98]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[99]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[100]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[101]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[16]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[102] value="3.体格检查" type="hidden">3.体格检查</td>
                <td><input name="tenthC[103]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[104]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[105]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[106]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[107]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[17]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[108] value="4.风险评估和询问指导" type="hidden">4.风险评估和询问指导</td>
                <td><input name="tenthC[109]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[110]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[111]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[112]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[113]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[18]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[114] value="5.早孕及妊娠与跟踪随访" type="hidden">5.早孕及妊娠与跟踪随访</td>
                <td><input name="tenthC[115]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[116]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[117]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[118]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[119]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[19]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[120] value="6.实验室检查9项（包括梅毒螺旋体）" type="hidden">6.实验室检查9项（包括梅毒螺旋体）</td>
                <td><input name="tenthC[121]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[122]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[123]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[124]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[125]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[20]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[126] value="7.影像学检查" type="hidden">7.影像学检查</td>
                <td><input name="tenthC[127]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[128]" type="number" ></input></td>
                <td><input name="tenthC[129]" type="number" ></input></td>
                <td><input name="tenthC[130]" type="number" ></input></td>
                <td><input name="tenthC[131]" type="number" ></input></td>
                <td><input name="tenthCl[21]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[132] value="四、院内感染控制" type="hidden">四、院内感染控制</td>
                <td><input name="tenthC[133]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[134]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[135]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[136]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[137]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[22]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[138] value="五、公共卫生信息管理" type="hidden">五、公共卫生信息管理</td>
                <td><input name="tenthC[139]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[140]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[141]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[142]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[143]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[23]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=tenthC[144] value="六、其他" type="hidden">六、其他</td>
                <td><input name="tenthC[145]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[146]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[147]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[148]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[149]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[24]" type="number" step="0.01"></td>
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            <tr>
                <td><input  name=tenthC[150]></td>
                <td><input name="tenthC[151]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[152]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[153]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[154]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[155]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[25]" type="number" step="0.01"></td>
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            <tr>
                <td><input  name=tenthC[156] ></td>
                <td><input name="tenthC[157]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[158]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[159]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[160]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[161]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[26]" type="number" step="0.01"></td>
            </tr>
            <tr>
                <td><input name=tenthC[162] ></td>
                <td><input name="tenthC[163]" style="background-color:#D1D1D1" step="0.01" readonly  unselectable="on"></input></td>
                <td><input name="tenthC[164]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[165]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[166]" type="number" step="0.01"></input></td>
                <td><input name="tenthC[167]" type="number" step="0.01"></input></td>
                <td><input name="tenthCl[27]" type="number" step="0.01"></td>
            </tr>


        </table>
        <p align=left>
            注：</br>
            1、某一项计生服务的收费收入不包括财政补助收入。填写过程中请注意收费收入总额与服务量和次均费用之间的勾稽关系。</br>
            2、各项技术服务的一级分类指标（如，一、计划生育；），其填写的“年度收费总额”、“服务量”、“卫生材料费”、“药品费”应该等于其所含的二级分类指标（1、健康教育、咨询和指导；2、避孕药具发放；3、放置节育器；4、取出节育器；5、输卵管结扎；6、输精管结扎；7、放置皮下埋植；8、取出皮下埋植； 9、人员培训和机构监督；10、其他计划生育服务）的相应指标的合计。</br>
            3、其他支出主要指开展该项服务时直接发生的印刷费、宣传费、邮寄费、公务用车运行维护费和其他交通费用等支出。<br/>
            4、如本机构无某一服务项目，请在对应的单元格中填“0”。</br>
            5、如提供的是免费服务，则收费总额和收费水平栏填写“0”。</br>
            6.表中没有的计生服务项目，可以明确一级分类的，需填写在一级分类下的“其他”服务中，如不能明确一级分类，则需填写在“六、其他”中，并在二级明细中填写具体的公共卫生服务内容。</br>
        </p>
    <button type="submit"><b>提交并进入下一表格</b></button>

    </div>
</form>

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